PARTNER Default Survey Questions
Q# / Question Text / Question Response Options / Notes on how question can be modified in the PARTNER system1 / Your organization should be listed below. If it is not, please return to the original email and click on that link. / This question is not modified, rather it is based on the respondent list
2 / What is your job title? / This can be modified to any question where you elicit a short answer, short open-ended response, for example, “what is your organization’s mission?” or “what is your motivation for joining?”
3 / How long have you been in this position (in months)? / This can be modified to any question where you elicit a numerical value as a response, such as “how long have you worked in the area of community health?”
4 / Please indicate what your organization/program/department contributes, or can potentially contribute, to this community collaborative (choose as many as apply). / Funding
In-Kind Resources (e.g., meeting space)
Paid Staff
Volunteers and Volunteer staff
Data Resources including data sets, collection and analysis
Info/ Feedback
Specific Health Expertise
Expertise Other Than in Health
Community Connections
Fiscal Management (e.g. acting as fiscal agent)
Facilitation/Leadership
Advocacy
IT/web resources (e.g. server space, web site development, social media) / The wording of this question can be modified to be customized to this network (this question is linked to Q5). Usually this is a question asking about what member orgs can or can potentially contribute to the network.
The response options listed here are from our default survey, but you can modify these to match resources/activities that you hope the organizations will bring to the network.
5 / What is your organization's most important contribution to this community collaborative? / Same as #4
6 / Outcomes of this community collaborative's work include (or could potentially include): (choose all that apply). / Health education services, health literacy, educational resources
Improved services
Reduction of Health Disparities
Improved Resource Sharing
Increased Knowledge Sharing
New Sources of Data
Community Support
Public Awareness
Policy, law and/or regulation
Improved Health Outcomes
Improved communication / You can customize the wording of this question (this question is linked to Q7). Usually this is a question asking about outcomes achieved or potential outcomes to achieve.
The response options listed here were pulled from your grant application, but we hope you will take a look over them to see if they fit with your outcomes/goals.
7 / Which is this community collaborative's most important outcome? / Same as #6
8 / How successful has this community collaborative been at reaching its goals? / Not Successful
Somewhat Successful
Successful
Very Successful
Completely Successful / This can be modified to any
question where you elicit a single choice response.
If this is a new network you can find another question to ask here if you do not think this fits.
You could ask what their potential role in the network could be or what level of involvement they could contribute.
9 / What aspects of collaboration contribute to this success? (Choose all that apply) / Bringing together diverse stakeholders
Meeting regularly
Exchanging info/knowledge
Sharing resources
Informal relationships created
Collective decision-making
Having a shared mission, goals / This can be modified to any
question where you elicit a multiple choice response.
10 / From the list, select organizations/programs/departments with which you have an established relationship (either formal or informal). In subsequent questions you will be asked about your relationships with these organizations/programs/departments in the context of the Network. / Question can be modified but response options will be based on the respondent list uploaded.
The next set, questions 11-18 are relational questions, meaning that the respondent will answer each question about the organizations they selected in Q10.
Q11-12: Below are the default questions, however there are several options for the content of these questions. At the end of this table are options we can choose from (in blue text), but all can be modified. Of the questions below in blue text, we can select up to 3 to include in the survey (the 3rd option will become Q19).
The wording of Q13-18 can be slightly modified for your network, but the context cannot change.
11 / How frequently does your organization/program/department work with this organization/program/department on issues related to this community collaborative's goals? / Never/We only interact on issues unrelated to the collaborative
Once a year or less
About once a quarter
About once a month
Every week
Every day / You can modify the language/wording of the question and response options.
12 / What kinds of activities does your relationship with this organization/program/department entail [note: the responses increase in level of collaboration]? / None
Cooperative Activities: involves exchanging information, attending meetings together, and offering resources to partners (Example: Informs other programs of RFA release)
Coordinated Activities: Include cooperative activities in addition to intentional efforts to enhance each other's capacity for the mutual benefit of programs. (Example: Separate granting programs utilizing shared administrative processes and forms for application review and selection.)
Integrated Activities: In addition to cooperative and coordinated activities, this is the act of using commonalities to create a unified center of knowledge and programming that supports work in related content areas. (Example: Developing and utilizing shared priorities for funding effective prevention strategies. Funding pools may be combined.) / You can modify the language/wording of the question and response options.
13 / To what extent does this organization/program/department have power and influence to impact the overall mission of the Network? *Power/Influence: The organization/program/department holds a prominent position in the community by being powerful, having influence, success as a change agent, and showing leadership. / Not at all
A small amount
A fair amount
A great deal / Questions 13-18 are based on validated scales to measure perceived value and trust among partners, so they generally need to remain as is, although we can customize for your network.
You can modify the language of the definition and what this term means to your group. Please to do not modify the response option scale as it is linked to the analysis tool and network calculations.
14 / What is this organization/program/department's level of involvement in the Network? *Level of Involvement: The organization/program/department is strongly committed and active in the partnership and gets things done. / Not at all
A small amount
A fair amount
A great deal
15 / To what extent does this organization/program/department/s contribute resources to the Network? *Contributing Resources: The organization/program/department brings resources to the partnership like funding, information, or other resources. / Not at all
A small amount
A fair amount
A great deal
16 / How reliable is the organization/program/department? *Reliable: this organization/program/department is reliable in terms of following through on commitments. / Not at all
A small amount
A fair amount
A great deal
17 / To what extent does the organization/program/department share a mission with the Network's mission and goals? *Mission Congruence: this organization/program/department shares a common vision of the end goal of what working together should accomplish. / Not at all
A small amount
A fair amount
A great deal
18 / How open to discussion is the organization/program/department? *Open to Discussion: this organization/program/department is willing to engage in frank, open and civil discussion (especially when disagreement exists). The organization/program/department is willing to consider a variety of viewpoints and talk together (rather than at each other). You are able to communicate with this organization/program/department in an open, trusting manner. / Not at all
A small amount
A fair amount
A great deal
19 / Do you have any questions or comments? / You can add any type of question here and after this point in the survey. If you added a 3rd relational question, you would do so here followed by any other question(s) you would like to ask.
SURVEY END
OPTIONAL RELATIONAL QUESTIONS FOR Q11, Q12, or to add as Q19.
Relational Question Options for Q11-12 / Please describe how your relationship with each of these partners was developed [pick all that apply] / 1. We don’t have a relationship yet
2. Through the network’s committees, task forces, trainings, focus groups, or other related activities
3. Our relationship was not developed through the network, but the network work has deepened our relationship
4. Through a partner of a network partner agency
5. The state mandated the partnership for grant funding.
6. Through other community venues/work not related to the network
7. Completely by accident (relationship was not related to work at all, for example we met at a grocery store)
8. Other
9. Don’t Know / You can modify the language/wording of the question and response options.
Relational Question Options for Q11-12 / How would you describe this organization as a current or potential partner? [please pick one]: / 1. None
2. Just learning about this organization, not really aware of how a partnership would benefit my organization
3. Aware of how my organization could benefit from a partnership with this organization, but have not built that relationship
4. Aware of how my organization could benefit from a partnership with this organization, and have interacted a few times to try out a partnership
5. Aware of how my organization could benefit from a partnership with this organization, and consider this organization a steady partner in our work
6. Fully engaged with this organization as a partner / You can modify the language/wording of the question and response options.
Relational Question Options for Q11-12 / Please describe the nature of your relationship with this organization/program/department [note: the responses increase in level of collaboration]? / 1. None
2. Awareness of what this org/program/dept’s role in the system (e.g. understanding of services offered, resources available, mission/goals)
3. Cooperative Activities: involves exchanging information, attending meetings together, informing other programs of available services [example: your org understands how to coordinate services/how to access services from this organization]
4. Coordinated Activities: Includes cooperative activities in addition to exchange of resources/service delivery; coordinated planning to implement things such as Client Referrals, Data Sharing, Training Together [example: your organization has coordinated services food systems in the community with this organization]
5. Integrated Activities: In addition to cooperative and coordinated activities, this includes shared funding, joint program development, combined services, shared accountability, and or shared decision making (Example: a formal program with funding exists between your org and this organization) / You can modify the language/wording of the question and response options.
Relational Question Options for Q11-12 / What kinds of activities does your relationship with this partner entail (pick all)? / 1. Conduct research
2. Develop Tools
3. Attend Conferences/Trainings
4. Provide training
5. Provide Educational programs
6. Technical Assistance
7. Legal/Regulation Change
8. Intellectual Exchange
9. New Technologies
10. Fund Research
11. Collect/store data
12. Develop standards
13. Advocacy/Awareness
14. Develop Guidelines
15. Service Delivery
16. Client Referrals / You can modify the language/wording of the question and response options.
Relational Question Options for Q11-12 / This partnership has [pick all]: / 1. Led to improved services or supports
2. Led to an exchange of resources
3. Led to new program development
4. Has been informative only (we only exchange information, knowledge about resources, etc.)
5. Improved my organization’s capacity
6. Has not resulted in any systems change
7. Has not resulted in any systems change, but we anticipate that it will / You can modify the language/wording of the question and response options.
6